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Sometimes with a chronic illness, it seems that as more symptoms appear more friends disappear. Is it you or is it them? Find out why relationships change and how you can stay connected with friends and loved ones despite your illness.

We’re joined by Dr. Jacqueline Olds, a psychiatrist and co-author of “Overcoming Loneliness in Everyday Life,” and Dr. Rosalind Dorlen, a clinical psychologist at Overlook Hospital in Summit, New Jersey.

As always, our expert guests answer questions from the audience.

Announcer: The opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.

Loneliness and chronic illness intersect in two very important ways. First, social isolation can make people more vulnerable to illnesses such as heart disease. And second, a diagnosis of chronic illness can itself be a very isolating experience even for people who have a good support network. Our guests tonight both have a lot to say about the relationship between illness and social isolation.

Joining us tonight is Dr. Jacqueline Olds, a psychiatrist and assistant clinical professor at Harvard Medical School, McLean Hospital, and Mass General Hospital. And she is a co-author with her husband, Richard Schwartz, of the book, “Overcoming Loneliness in Everyday Life.”

Dr. Olds, welcome.

Dr. Jacqueline Olds: Thank you so much for having me.

Judy: Sure. Also with us tonight is Dr. Rosalind Dorlen, a clinical psychologist at Overlook Hospital in Summit, New Jersey. Dr. Dorlen, who has a special interest in psychological issues associated with chronic illness, is also on the faculty of Rutgers University.

Thank you for joining us, Dr. Dorlen.

Dr. Rosalind S. Dorlen: It's really my pleasure to be here tonight.

Judy: Good. Well, let's start with the bigger picture. As a society, we've become quite isolated from each other and quite lonely, it would seem. In fact, I would like to start with a story that has become a classic in the medical literature. More than a hundred years ago a small group of Italians left Roseto Val Fortore, a village in the foothills of the Apenines, in hopes of making a better life in eastern Pennsylvania. They named their new village Roseto and soon recreated the strong ties that they had had in Italy. They lived in three generation households, centered their lives on family, and built their houses so close together that they could easily call to each other.

To make a long story short, when researches studied them 40 years ago, they were stunned to find that while the town of Roseto had the same water supply, doctors, and hospital as nearby villages, the town had only 40 percent as many heart attack deaths. The apparent reason: closer ties between people. Predictably enough, in more recent years as younger generations have moved away from the town, their heart attack rates have gone up, just like people in nearby towns.

So, Dr. Olds, U.S. census data shows that in the year 2000, 25 percent of households consisted of one person living alone. In 1940 it was only 7.7 percent. Why are we so much more isolated today?

Dr. Olds: Well, it's such a complicated question, and many people are trying to answer it, but I think people are pushed by the many demands of life today to try to retreat from the crowd a little, and often they are working so hard that they don't have time or energy to arrange a social life. They also often want a simpler, more self-reliant life in which they don't have to depend on others who might let them down. So we think that in little steps they isolate themselves and find later that they are not too pleased with how disconnected they have become.

Judy: Well, Dr. Dorlen, what's your take on this? Why do you think we are more isolated today?

Dr. Dorlen: Well, I am reminded of the images of people on the roofs after Katrina, and we saw people who were basically helpless and many of whom did not know someone who even had a car.

Listen, we've become very mobile. People have a lot of professional responsibilities, long commutes, two family household workers. And, you know, I'm thinking about the Internet, which of course has created an enormous revolution, and people are spending three hours a day on the Internet. It's improved our quality of life for sure, but it sure has restricted our social interactions with each other.

Judy: Yeah. I met a woman a few months ago who was very lonely and got up every morning to play bridge on the Internet. And I thought, “Why don't you just go play bridge at nighttime with some real people?”

Well, obviously living alone is not the same thing as being lonely. You can live alone and not feel lonely, and you can be in the middle of a huge family and feel very lonely. Is the issue living alone, or is it how emotionally connected you are to other people? Dr. Olds, tell us about that, and also about a recent Duke study that talked about how many confidants a person has. It seems to be the case that nowadays 25 percent of people have nobody to talk to. What's going on here?

Dr. Olds: Well, we don't know for sure that they have nobody to talk to, but when they were asked the question, which was approximately, “Have you talked about important matters with anyone in the last six months?” In 2004, twenty-five percent of people said no.

Judy: That's amazing.

Dr. Olds: Isn't it amazing? And in 1985, more like seven percent said they had nobody to talk things over with. So somehow people are getting out of the habit of discussing really important matters with a few people that they trust.

Judy: But why would that be?

Dr. Olds: My notion is that people are taking these little steps kind of in retreat from the crowd and are sort of isolating themselves in tiny little steps, like spending more and more time in front of the Internet, etc. It may be that they start to feel kind of left out and mistrustful and feel like everyone else is kind of socializing without them, and they don't want to reach out as much. And they get kind of rusty about reaching out.

Judy: Dr. Dorlen, what do you make of this declining intimacy?

Dr. Dorlen: Well, along with this declining intimacy, we have increasing rates of depression, and I wonder if this is not just an accident. This is something that I hear in my office a lot from patients of mine who basically say they need to talk about things that really matter. Intimacy is exactly that. I think maybe what we have substituted is watching “Desperate Housewives,” and does that really provide a connection or a substitute for a connection?

So, I see a sense of an inability of people to reach out, and whether the TV and the Internet and these other wonderful gadgets have played a role, whether they're the cause or whether they're the effect, isn't really clear to me, but there is clearly a change in the nature of intimacy.

Judy: Well, intimacy itself hasn't changed, it's just people are getting less of it. Isn't that true?

Dr. Dorlen: Quite.

Judy: Right. So if we all unplugged everything electronic in our houses, we might go out on our front porch and talk to our neighbors?

Dr. Dorlen: We might, or we might just get more depressed. I don't know.

Judy: Yeah. Hard to know which comes first.

Dr. Dorlen: Yes.

Judy: But this seems like a fairly long term trend, and the Internet is relatively new. Is this true in other cultures? Do you know, either of you, whether this move away from confidants and intimacy is happening there too?

Dr. Dorlen: Well, I think in Western Europe the trend toward more isolation and more people living alone is not nearly caught up with us, but is sort heading in the same direction. But there are cultures where essentially no one can achieve isolation. In India people who come to America say that they never felt lonely in India. If anything, they felt a longing for solitude.

Judy: Right.

Dr. Dorlen: So it's clear that there are many cultures in which it's simply not an option to be lonely.

Judy: Right. I've heard of people in Russia who try to get divorced, and they can't. The courts don't move fast enough, so they end up still sharing an apartment, and they can't find a new apartment, so they put a curtain down the middle of the apartment they have got.

Dr. Dorlen: That's true.

Judy: I guess either extreme is bad. In the book, “Bowling Alone” by Robert Putnam, he cites studies showing that the more integrated a person is in his or her community, the less likely that person is to have colds, heart attacks, strokes, cancer, depression, in fact, death from all causes. And I guess studies over the last 20 years in the U.S., Scandinavia and Japan suggest that people who are socially disconnected are between two and five times more likely to die from all causes compared with the more connected people.

Dr. Olds, let's start with you. What is connectedness doing for us physiologically or medically?

Dr. Olds: Well, in ways that we don't fully fathom, it seems to boost our immune system and it seems to lead to a sense of more well being. In a way, connectedness needs to be further defined, because if we are in a room full of strangers who we are not talking to, we don't get that same boost. So essentially being with people who know us and especially know us well does us a lot of good in ways that we don't entirely understand.

But we know that touch, for example, being touched and touching has enormously relaxing and soothing effects and lowers our blood pressure and boosts our immune system. So it really has a big medical effect. And I think there was somebody who said that connectedness is more important than smoking or not smoking, that essentially it's as huge a medical factor.

Judy: Yeah. I read that too. So, touching - you could even, if you can't get a person, get a dog or a cat.

Dr. Olds: Exactly.

Judy: The contact doesn't have to be human.

Dr. Dorlen, what do you think about why connectedness makes such a big difference and is so fundamental?

Dr. Dorlen: There is so much research that supports the fact that social isolation has a great impact on mortality. By the way, Dr. Olds, you mentioned the dog. We are finding more and more that people who connect with animals, in fact, feel better and levels of depression seem to be alleviated.

One of the thoughts that I am aware of is the fact that when people are really isolated, they become anxious, and anxiety is, in fact, a product of isolation. And we do know that anxiety produces enormous physiological effects. We all know about a lot of studies that have said, for example, that married couples live longer. I often wonder: Do they live longer, or do they just think they are living longer?

Judy: It just feels longer.

Dr. Dorlen: All those studies seem to point out that there is greater health with marital partners. Now, when we look at those kinds of connections, maybe it has to do with having another person in one's life encourages healthier behaviors, sending people to the doctor, or possibly being a good listener. Any of these things may be part of why mortality rates are impacted by social isolation.

Judy: Yeah. There was a big study on caregiving earlier this year.

Dr. Dorlen: Right.

Judy: And the people who were very connected to other people really didn't suffer as much - like in terms of dying after your spouse dies, the really high stress situations - as the more isolated people.

Dr. Dorlen: Because they had built networks, and they were feeling more part of the social fabric of their group.

Judy: So let's take it as a given that being emotionally isolated is a bad thing, and we don't need to go through all the studies that show that, and I agree with you there is lots. But to move this on to chronic illness, chronic illness often means that, because of very real physical limitations and also the psychological challenge of coping with a disease, a person can end up feeling isolated.

Dr. Dorlen, why is social isolation so often a harsh reality for people with chronic illness?

Dr. Dorlen: Well, you know what I've noticed with a lot of the people that I work with with chronic illness is they feel different. They don't want to complain much. Sometimes they will refrain from connecting altogether because they don't want to come through in a dour, a disconsolate way. There are a number of people who might be shy or tend to be isolated before they are chronically ill, and so the development of a chronic illness is just going to exacerbate their feelings of loneliness or their tendency toward isolation.

Judy: But on the feeling different part, why wouldn't a support group with other people with the same illness be a huge help? Or is it?

Dr. Dorlen: Well, it is a huge help. There is no question about it. The real challenge and the clinical challenge is helping people to be able to reach out. Yes, support groups are wonderful. I am thinking of a woman I worked with whose child had cystic fibrosis, and she had no one to talk to about it, at least she thought. She would wake up in the middle of the night, and she would get on the Internet. She connected in that way. She didn't feel so different, and that enabled her to sign up for a couple of support groups that were local.

Judy: So she actually used this mixed blessing of the Internet to connect?

Dr. Dorlen: That's right. You have got to realize it's a mixed blessing.

Judy: And then get to be with real people. For both of you, is the specific chronic illness a factor? I mean, is it more isolating to have cancer or arthritis or MS? Is one more isolating than the other? Dr. Olds, do you want to take a crack at that?

Dr. Olds: Well, I think the more scary an illness is, the more a person feels different and sort of naturally isolated, and other people who find out about it are a little more terrified because of their own fears of mortality. I've known so many people who knew they had cancer and didn't want anyone to find out anything about it for fear they would be treated differently and it would scare everyone half to death.

Judy: Or they would only be seen as a patient, not their real self.

Dr. Olds: Exactly. That's right. That's a good point. So it's a checkered proposition if you can find other people who are in the same boat to talk to.

Judy: Right.

Dr. Olds: But it's a big jump to find a support group that feels just right.

Judy: I do think maybe it's a result of media exposure, but cancer is pretty socially acceptable these days. I have a friend who had cancer, and her husband has Alzheimer's, and she was really struck by how much more support there was for cancer than for Alzheimer's.

Dr. Olds: Certainly.

Judy: Cancer has had sort of a longer public visibility to reduce some of the stigma.

Dr. Olds: I think that's true.

Judy: Yeah. Well, Dr. Olds, is part of the problem that people with chronic illnesses actually do have more pain and more fatigue and, whatever the psychological factors, these real medical things kind of get in the way of getting out of the house?

Dr. Olds: I think that's absolutely right, and I think that really when we are looking at these statistics about people socializing less, we see that even perfectly healthy people have a little trouble getting themselves out of the house.

Judy: Right.

Dr. Olds: But if you have got a chronic fatigue situation or pain or lack of energy, you have a got a very good rationalization of why you wouldn't want to have to get out of the house. And in a way, we might suggest to many people with chronic illnesses that the task at hand might be to have people in the house rather than force themselves to get out of the house more than they already are, especially if the pain is really severe.

Judy: Yes. I know you mentioned that to me in an e mail, and what's the barrier there? Is it people thinking, “Oh, my house is too messy,” or, “I don't want to have to cook food for people.” What's the barrier to having people in?

Dr. Olds: I think if you get out of practice with having people in, it feels like it's going to be a huge deal, and you get paralyzed by the worry of not doing enough or not somehow being impressive enough. Even people without chronic illnesses will stop socializing if they don't have a good answer to the question “What do you do?”

If they don't like the fact that they don't like their job at the moment or they are between jobs, they simply will stop socializing, which is astounding. And so with a chronic illness, having to tell people what the illness is or having to talk about embarrassing details is sometimes too much for people.

Judy: Is there a way around that? For either of you, Dr. Olds or Dr. Dorlen? We were going to get to this later in the show, but now is a good time. How do you answer the question, “How are you?” Or how do you answer the question, “What are you doing these days?” if what you are doing is taking care of yourself?

Dr. Dorlen: That “How are you” is a very interesting comment, because most of the time when we ask people “How are you,” it's really just part of the greeting, of hello. And so what I hear from so many chronically ill people is they kind of are able to perceive when a person really is asking “How are you” as opposed to the perfunctory “Hi, how are you doing.” And when they are truly asked, and a person says, “Hey, how are you really doing?” they are willing to answer because they know that the person is really curious and really interested in them and really wanting to reach out supportively.

Judy: It's a real invitation to talk.

Dr. Dorlen: It really is. It's different than, “Hi, how is everything going?” And then you just walk on, you know.

Judy: Fine.

Dr. Dorlen: It's true. But I also think sometimes the chronically ill person needs to be sort of coached in recognizing what questions they would have if they were talking with some of their friends who were ill.

Dr. Olds: That's a good point.

Dr. Dorlen: So you could already sort of anticipate what questions most people would have and answer them before they've even asked those questions and put them at their ease.

Judy: Can you give me an example?

Dr. Dorlen: Well, let's suppose that the person is worried about your illness. And so you could say, “Don’t be worried so much about how I am. I'll tell you if I run out of energy or need your help.” So essentially you are anticipating their worries and answering some of their questions so that they don't have to feel too awkward. Or you might say, “I bet you are wondering about my illness and how it makes me feel, so let me tell you a little bit about it.” And then you don't want to go on and on necessarily, but you can just give them enough information so they're not at sea.

Judy: Well, again to both of you, how can a person with chronic illness recognize either when they are depressed or they have got other signs of isolation? Are there some handy ways to tell? Maybe some people don't even realize how isolated they are. Dr. Olds?

Dr. Olds: Well, there are the famous, what they call “vegetative signs” of depression - often slowed down, not having the usual pleasure in things, not having a good appetite. Sometimes a change in weight, which if it goes up or down by five percent of your body weight, is a worrisome sign.

Judy: When you are not trying to make it go up or down.

Dr. Olds: Exactly. Feelings of worthlessness, recurrent thoughts of death. But what's interesting about many of these things that are seen in depression is that they are often seen in chronic illness too, and so that does make it quite confusing. I have seen so many patients who have been ill, let's say with a bad bronchitis or pneumonia, who mistake the fatigue from having been so ill for depression. And they have to be reminded that of course if you have had pneumonia for two weeks, it's going to take six weeks before you feel your normal energy level.

Judy: Right.

Dr. Olds: But when you are fatigued and you have a low energy, it's very hard sometimes to distinguish whether it's depression or the illness.

Dr. Dorlen: I think that the litmus test very frequently between chronic illness and either mild to moderate depression seems to be the self esteem factor. When people are really depressed, they are very, very angry at themselves, and they are feeling awful about themselves. The anger is directed inward. What I find with many chronically ill people is they sort of get past that, and their energy sometimes isn't directed against themselves. They can sometimes summon up their anger energy against the disease or the illness, and they are not blaming themselves.

Judy: How do you get from A to B on that one? How do you get from feeling awful about yourself to being angry that you have this situation to deal with? That's assuming that's the direction you want to go.

Dr. Dorlen: Well, I don't think it's linear. I kind of feel that some people seem to respond to illness in their own idiosyncratic way. But, look, there is no question about it, people who are chronically ill experience bouts of depression, and people who are chronically ill experience bouts of actual physical disability at times, which can be confused for depression or maybe, in fact, accompanied by depression.

Dr. Olds: That is so interesting. I was also reminded of a very old study - it must have been 20 years ago - that I heard that people with rheumatoid arthritis were protected from many of the mental illnesses, whether it was psychosis or depression or all sorts of sort of emotional symptoms. And no one quite understood why, but people wondered whether, because you could mobilize people around the rheumatoid arthritis, maybe some of the emotional symptoms weren't as necessary.

Dr. Dorlen: You know, that's a good point, Dr. Olds, because what I have seen with many of my patients with multiple sclerosis very frequently is euphoria. And they will say, “Gee, I can't understand this. I am not doing well physically, and yet I am not feeling as depressed as I might think I would be or project myself to be or would have thought I would have been five years ago.”

Judy: And why do you think that is? Is it because it's a real disease? You are not making it up. It's really real, and you don't have to think there is something wrong with you emotionally. You've got a real problem. Is it that kind of externalization?

Dr. Olds: I think that might be part of it. I think medical illnesses are much less stigmatized.

Judy: I think that too.

Dr. Olds: So I think that probably is a little bit of the reason.

Judy: No, I remember my mother who was sort of a worrier all her life, and then she got leukemia, and she got happier. You know, kind of, it was real.

Dr. Dorlen: Exactly. She suffered from the diseases of the “what ifs” for so long and when she actually did deal with a real issue, she was able to use the problem solving resources of her personality and wasn't dealing just with the disease of the “what ifs.”

Judy: Well, even doctors don't always recognize the signs that somebody is depressed, and I think patients sometimes don't bring them up because they are embarrassed. So even in this human interaction when you are seeing the doctor, I think sometimes the fact of the person's emotional state gets overlooked. What do you think, Dr. Olds? Does that happen?

Dr. Olds: Oh, I do. I think people are certainly ashamed of feeling lonely. They are perhaps a little less ashamed of feeling depressed. But if they have got a real medical diagnosis with a whole set of recipes for getting better and a whole set of doctors and specialists, it's very much less a matter for shame.

Judy: Well, I would really like to pursue that a little with both of you. Jackie Olds, why is it shameful to be lonely? Why does it feel shameful to feel lonely? There is something really important in that.

Dr. Olds: I think there are two reasons. All through history as we know it, being shunned or put in exile was the worst possible punishment, that being set apart from the mainstream, the tribe, was a terrible punishment.

Judy: Right.

Dr. Olds: And then I think in our country in particular that we have a kind of idealization of being able to be very self reliant and independent, and so that makes people think that they are supposed to be able to be alone and not mind it. And we've got a whole lot of folk wisdom about how you are supposed to be able to love yourself and be alone before you can possibly love anyone else.

Judy: Yeah, I know.

Dr. Dorlen: We are the only culture that mutters that silliness to each other.

Judy: It really is silly. Obviously there's some wisdom in it, but really it's offensive.

Dr. Dorlen, what do you think? Why do people feel ashamed for feeling lonely?

Dr. Dorlen: Well, I think that loneliness too is associated with rejection, and the difference between being alone and being lonely is a psychological difference.

Judy: Tell us what that difference is.

Dr. Dorlen: Well, I think being alone is really being with one's self. And that isn't really as lonely as having a sense of emptiness that's associated with loneliness.

Judy: Yeah. The worst feelings are when you sort of abandon yourself…

Dr. Dorlen: Exactly.

Judy: …and you are not even there with yourself. That's very true, and I'm not sure that's a distinction that a lot of people make.

But, Jackie Olds, go back to what you were saying, and this kind of myth of you are supposed to be okay alone, or it's a sign of weakness to need other people. Tell us a little more about that.

Dr. Olds: Years ago, I guess it was '96, when my husband and I wrote this book called, “Overcoming Loneliness in Everyday Life.” We were essentially trying to write the book in order that people who felt lonely - and we felt that everyone went through times in their lives when they felt terribly lonely - was not something to be so shameful and that people should understand that it's kind of a natural part, especially of life in America where we are expected to be able to move away from home. We are expected to be able to live in apartments by ourselves. So many people have such expectations of why they should be totally independent.

And there is also the fact that people who settled in America, or the immigrants who left the old country, felt they had to be tie breakers in order to come to America. So we sort of idealized the idea of being able to be super independent in a way that other cultures haven't really made that same mistake, or many cultures haven't.

Dr. Dorlen: Do you find, Dr. Olds, that we even do this in terms of our child rearing? It's a very unique fact of American culture that our children are expected from day one after they are born to sleep in their crib in another room. Other cultures view that as absurd.

So, we have idealized the culture of individualism. This country was founded on individualism, but there is something about all this individualism that doesn't provide sufficient balance in terms of community and community connection.

Dr. Olds: I think that's completely true, and I am always trying to encourage people to essentially embrace the culture of give and take. You know, if you take care of your neighbor's plants and they take care of your plants, pretty soon you've got a friendship going.

Judy: Yeah.

Dr. Dorlen: You know something? Friendship is a plant of slow growth.

Dr. Olds: It is. It takes much longer than people think, but basically if you reach out and people reach back, it will happen. It's just slow.

Judy: That's true.

Before we get back to what we were talking about, we have a couple of e mail questions that have come in. There is one from a person who does not say whether the person is a man or a woman or where they are from, but here is the e mail. This person has had a chronic and disabling illness for 23 years. “About eight years into it,” the person says, “I sought counseling and was amazed to learn that spouses are often not supportive because they are angry at you for giving your time, energy and yourself to your illness.”

The therapy allowed this person to quit being angry at the spouse and others for being angry at, let's say, her, and things have gotten better.

How does anger fit in, and how do you learn to deal with the people who are dealing with you about your illness? Dr. Dorlen, you want to start with that one?

Dr. Dorlen: I just have one question. Was the person saying that the spouse is angry because the patient is now talking to a psychologist or another mental health professional?

Judy: No.

Dr. Dorlen: Maybe I didn't catch that part of it.

Judy: It was a little bit confusing, but I think the patient was saying, let's say it was a woman, was feeling that her husband was angry at her for spending so much time thinking about her illness and taking care of her illness. And she eventually quit being angry at him because of that and gave up some of her anger in general, it sounds like, and that that sort of helped with the relationship with the husband.

Dr. Dorlen: Well, it's an interesting thing, because sometimes when a chronically ill person is part of a relationship and they are not able to communicate with their partner in a way that helps them feel connected, sometimes the spouse will be resentful if the patient starts to talk to a mental health professional and maybe stops talking to them. I have seen quite a bit of that, because it sort of changes the fulcrum of the relationship.

But what I think this e mail really refers to is a person's anger, and it's very possible that being in some treatment, psychological treatment, that the person is able better to understand their anger, better to get a handle on it.

Judy: And their spouse's anger.

Dr. Dorlen: Be less frightened by their anger, and, in fact, be able to focus the positive aspects of their personality in a better way because they, in fact, may have made peace with their illness, and they are not as angry. So that's one hypothesis. I am sure maybe we can generate some others.

Judy: Jackie Olds, what's your take on it?

Dr. Olds: Well, I think one of the most difficult things about illness, and I speak from my own experience when I have been ill, is that it makes you feel incredibly self absorbed. You start to think about, “Where are the aches? Where are the pains? How are you feeling today?” You start taking your own pulse in a thousand little ways. And pretty soon you want the whole world to be thinking about your illness because you are so fascinated by it.

Judy: Right. Exactly.

Dr. Olds: And it is true that the other people around you who are trying their best to be sympathetic can get depleted by one's self absorption during the illness. So I think that, in a way, chronically ill people have to be reminded that the rest of the world can't live quite in their shoes and needs to have time to talk about themselves even though they don't have an illness that gives them a special entitlement for speech.

Judy: Right. A jealousy thing.

Dr. Olds: What I notice is that the chronically ill person very frequently doesn't feel self absorbed. They become self absorbed. And the people around them experience their withdrawal. And that possibly can engender anger and a feeling of neglect.

Judy: Yeah. That's very true. The chronically ill person is sort of married to the illness, not their spouse.

Dr. Olds: Yeah, yeah. That's a good way to look at it, isn't it?

Judy: Yeah.

Dr. Olds: I wanted to make one other tiny point and that is that when couples are usually working so hard at their jobs and with their children nowadays, if one adult is kind of taken out of the rotation and can no longer do all the things they are expected to do, the other person naturally gets incredibly resentful because they are sort of working double time.

Judy: Oh, yeah.

Dr. Dorlen: That's a good point.

Dr. Olds: Even the most saintly people end up getting resentful, and if they can possibly think of a way to put that in their schedule, therapy can be helpful. But really in the best of all worlds, you would want to have a whole social system that gave help to somebody when there was chronic illness in the family so that the family didn't go under too.

Judy: Yeah.

We have got another e mail. This one is a very sad one, and again, I can't tell if it's a man or a woman, but let's say it is a woman. She writes, “I am a chronic pain sufferer whose friends left years ago. I have me and my dogs and that's it. Quality of life is nil, and it is as if I have been on an eight year death watch.” That's how long she has been sick. “Why bother living any more? I am in pain that even multiple narcotics cannot touch. I am 53, if that matters. The chance of romance or even good friends is nil. I can't drive. A van takes me shopping once a week. I have tried to be thankful, really I have, but when my last dogs are gone, so am I.”

What would you say to someone who is feeling this isolated?

Dr. Olds: Well, I think she is reaching out, and I think she is giving voice to feelings that perhaps she has said to no one. I have a kind of positive feel that this is a person who needs to have a consult about chronic pain. You know, in the past eight years we have made enormous increases and advances in our knowledge of the management of chronic pain conditions, and this is a woman who not only needs amelioration of her chronic pain, but she also needs to connect and to be able to get back, to return to life. Yes, her dogs are wonderful, but dogs…

Judy: …are dogs.

Dr. Olds: They live much less than humans and she needs to connect with people in the process. Maybe this is a person who, if she can feel a little bit better with her chronic pain - and I hope she's listening - that maybe she will reach out to one of the dog training programs or one of the programs where you bring dogs to the hospital and help other people and reach outside of herself once that pain management is handled. And I hope she is able to do that.

She has got two important steps. One, a good consult on the chronic pain, and then she needs to get herself in the hands of a good therapist who is going to really help her explore her resistance to reaching out to people so she can outlive her dogs.

Judy: Exactly. I mean, you have both made really good points, and I just want to chip in too that I think it's great that this person e mailed us, and I would just remind this person to go in the archives of the show because we did have a very good show on pain earlier in the year, and that's in the archives.

We have got a caller on the line. Ed from Pennsylvania, are you there?

Caller: I am.

Judy: What's your comment?

Caller: It's interesting that I tuned away as you got a phone call, and I just heard the last little bit of it, but it relates to what I want to comment on.

Judy: Sure.

Caller: I had somebody who is in severe chronic pain call me probably 20 times, and some of the phone calls were an hour long, and one lasted two hours long. They were all about her and the terrible things that were happening to her. And when I finally said, “I don't have time for this,” you know, I would not stop the conversation because I didn't want to offend her. But when I finally did, she was offended, and she said, “Well, my time is important too.”

Judy: Was this a friend? Was this someone you knew?

Caller: No, well, I met her in a grocery store, and she told me later that she often goes to the grocery store because she gets so seriously lonely. But I couldn't get away from her, but I offered her the phone number, thinking that we might have a ten minute conversation.

So, in essence, she was talking to a stranger but wouldn't pick up on hints. And I think it's sort of the theme or one of the things you have been talking about: how people’s illness can become the whole heart of their world. I mean like 90 percent of it, yeah.

Judy: Their whole identity.

Caller: And connected to that is this notion that if you are in chronic pain, you don't feel like you can really maintain a relationship, and so it becomes difficult to sort of get out and socialize and so forth because you don't know if you are going to be able to do it. I mean, I share part of that. There are days that I can't do things. Because you don't know that you are going to be able to participate on a given day, you are hesitant to make commitments. There are sort of two comments there.

Judy: Well, Dr. Olds and Dr. Dorlen, let's talk about the first one, the obviously very needy woman who took advantage of this man's nice offer to be on the other end of the phone for her. How do the good Samaritans, or whatever you want to call people like this man, handle a situation like this?

Dr. Dorlen: Well, one has to balance sensitivity to other people's needs with the recognition that one has needs of one's own. So I think after listening patiently as you did, you probably listened probably more patiently than 99 people out of a hundred would listen, but at some point you need to say, “Look, can we have this conversation another time? I need to leave. I have something to do. Thanks for calling.”

Caller: I did that several times. Go ahead.

Dr. Dorlen: But I would bet this person was a little bit entitled long before the illness struck, because it seems to me anybody with that kind of entitlement thinking that you could listen for hours on end when she didn't know you…

Caller: Well, she was highly offended. Actually she was irritated because I asked a question for clarification. She had spoken of her stepfather several times, and sometimes she mentioned her father, and I said, ”Well, what is the story with your father?” And she was silent for a long time, and she said, “I don't have to answer that.” And this is after talking to me about 20 hours, so there are all these landmines.

And then she got quite paranoid, and she would call me one call after another saying, “Why did you ask me this? Why did you ask me that?” I just don't understand this. And so I actually had to finally tell her not to call me anymore.

Dr. Olds: I am afraid, sir, that her diagnosis was not just chronic pain. I think that she has a psychological diagnosis as well, and that piece of her behavior may be more difficult to manage than her chronic illness.

Judy: Well, Ed, you are a champ for trying, and this probably fits in the “No good deed goes unpunished” category.

Dr. Olds: Well, what you said at the end - I just want to comment, Ed - you were saying that you have dealt with times where you don't feel like you can go out and do things. And I have been thinking lately, as I am about to turn 60, that old age is kind of like a chronic illness. You know, let's face it.

Judy: Hey, that's not old.

Dr. Olds: But everyone that gets older has aches and pains, and you sort of have to monitor yourself. What we think of as a healthy adjustment to old age is that you continue with life anyway even though you have to adapt to aches and pains.

Judy: It hurts. Right.

Dr. Olds: And so in a way, a chronic illness is a more extreme form of that, but we should remember that everybody has to adapt to aches and pains.

Judy: That's true. Ed, thank you so much for your call.

We have another e mail from Jane in Wisconsin. She writes, “What happened to me when I had a back injury that took a long time to recover from was that people would ask what I needed, and I felt embarrassed to say, ‘Can you weed my lawn?’ But then my garden club came over and weeded without asking me, which was great. The help was just offered. I think that's what people should do.”

Do both of you want to make a quick comment on that?

Dr. Dorlen: I really have something to say about that, and this is a little wisdom I got from my own mother. She had a chronic illness that she was dealing with, and 80 people were calling her, “Oh, just let me know if there is something I can do.”

But there was a very nice gal who came to the house one day, brought some lunch, they sat down and had lunch, and she said, ”There's a difference between the vague, ‘Oh, let me know what I can do,’ versus somebody just reaching out and doing something.” That is true.

Judy: Yeah. Yeah.

Dr. Olds: That is true. But I've been impressed that some of the people, let's say, who are going for an operation where there is going to be a six month recovery or something, that every now and then they send out an e mail saying, ”It would be wonderful if all of my friends could somehow organize things so they could come on visits and things.” And it usually turns out that everybody's life who gets on that e mail list and is sort of given the opportunity to come on regular visits and bring food has their own life enhanced by that opportunity. So it's sort of good for the helpers as well.

Dr. Dorlen: Isn't that what Benjamin Franklin said? If you want to make a friend, do a kindness for someone.

Judy: Be one. Yeah.

Dr. Olds: Exactly. Exactly.

Judy: Dr. Dorlen, I know that you are involved with the American Psychological Association and you have been doing some research or know about some research on something called post traumatic growth that, I gather, describes people who have developed their resilience as a result of trauma or illness. Can you tell us a little bit about that?

Dr. Dorlen: This is a very interesting area, because it has been observed by many people that when an illness or even another kind of tragedy happens, most people assume that the end result of that is just awful. But when you listen to some people who talk about growth in terms of their own spirituality, a deepening of their relationships, a greater sense of their own self worth, it becomes clear that after trauma - and certainly the onset of illness can very frequently be very traumatic - that the working through of that illness can very frequently have benefits that support growth, spirituality, and better relationships.

Judy: We often hear that people say about their illness that this is the best thing that ever happened, and I'm sure that's both true and not true. But in the sense that it's true, Dr. Jackie Olds, can you tell us a little bit about this? How you can actually use this as an opportunity to grow? I mean, it's basically either grow or go under, as I see it. How can you use this very real tragedy that you have to grieve and cope with but also as a spur to growth?

Dr. Olds: Well, I think you're absolutely right that it really is a question of grow or go under.

Judy: Yeah.

Dr. Olds: But any possibility of adapting. I have always had a sort of philosophy that you have to sort of keep limber and be ready for any possibility, and I think all of us, maybe since 9/11, have felt that. You know, life isn't going to be as predictable as we quite thought. And similarly with illnesses as you get older, you sort of have to be ready to adapt and change fast if some brand new situation comes down the pike. And it turns out that that is, in fact, the best use in a way of our minds and our natures to be able to adapt to a new situation and make the best of it.

And so if you can help people to recognize that if they have to stay in bed for two weeks, well, how often do you get a chance to stay in bed for two weeks and sort of think things over instead of just running pell mell through your life? And so there are so many opportunities in something as unusual as an illness or trauma. And many of them are terrible things, but they don't all have to be terrible.

Dr. Dorlen: I think this really leads to the subject of resilience.

Judy: I was just going to go there.

Dr. Dorlen: Were you? Because after looking at the kind of emotional pain and fear and sadness that are common in people facing chronic illness or trauma or adversity, the ability to cope effectively is called resilience, and that really means to be able to bounce back.

Dr. Olds: Right. Land on your feet.

Dr. Dorlen: Yeah. And I don't believe that that's something people are just born with. Some people are born with a greater capacity for resilience, but I do believe that these are behaviors, thoughts and actions that can be learned and enhanced.

Judy: Well, let's go into that a little more. What can be learned? What can we learn from this?

Dr. Dorlen: Well, we can learn that, for example, we can modify our attitude by maintaining a more positive outlook. You are better able to be involved with your care and less likely to give up on yourself by being willing to change, which is an important component of resilience. You are able to confront challenges and work toward positive growth.

Judy: But it's obviously tricky. I can offer a personal example here. My husband just died this summer, and I am certainly trying to use the grief process as a chance to grow, and I think that's working. On the other hand, it really matters how people make their suggestions to you. If someone says, “Well, just grow for heaven's sakes.” I would feel very resentful. If somebody said, “You know, it really does hurt, and it really is awful, and you are doing great and keep doing what you are doing with just trying to grow.” The way the message comes across makes a huge difference.

Dr. Olds: Yes. That's correct.

Judy: Whether you are told to just have stiff upper lip, which is really not the answer, or, you know, do something deeper.

Dr. Dorlen: Judy, you know, one of the things that dealing with the loss of a loved one, of a spouse and one of the things in common with dealing with a chronic illness is that there is grieving involved in both.

Judy: That's right.

Dr. Dorlen: The grief of the loss of the loved person and what this person represents to you and the grieving of the loss of the health, the change. And both of these are processes that can't be hastened by someone telling you to snap out of it and being impatient. These things have their own way of moving forward, and not everyone works on the same timetable.

Judy: Yeah. I think that's the point I was trying to make, that there is grief involved, and there is grief involved with coping - being diagnosed and then coping with a chronic illness. And you can't sort of hop over that phase and just immediately be resilient. There is a whole process involved.

Well, I know you have both had a lot of experience working with chronically ill people one on one. Can you both give us some examples on how you have coached, for lack of a better word, your patients into using their illness as a growth experience, for lack of a better term?

Dr. Olds: I have one patient that comes to mind, she must be about 37 now, but she has had a wide variety of peculiar symptoms that probably will coalesce someday into a diagnosis of an autoimmune disease. But what I found wonderful about her attitude is that she was always sort of scientifically experimenting and finding out new solutions to problems as a new symptom would come up and that she was kind of interested in this. And as it happens, about two years ago she thought even though she is older, she would just go to medical school because she has gotten so interested in the way in which people can learn about themselves and solve some of the problems that come along the way that she wants to make a profession of it.

Judy: That's great. Wow.

Dr. Olds: And she is a particular pleasure to work with.

Judy: Yeah, I bet.

Dr. Dorlen: I am thinking of a patient of mine who had a severe case of cystic fibrosis, and at the age of 23 was very, very, very sick, gravely ill, and was waiting for a transplant, and at the brink of death she was able to receive a double lung transplant. It took her six or seven weeks in the hospital for recovery because she had been so gravely ill beforehand.

Once she had recovered and was adapted to the medications, the various immunosuppressant medications, she became very depressed. And the depression had to do with her near death experience and also some issues about did she have the right to survive and that she took someone's lungs who had to die. Of course, that was an accidental death of the donor.

Nevertheless, one of interesting things that has happened in working with her, and she is a current person I am working with, is that she has deepened her interest in the whole process of transplantation and has signed up to do some volunteer work in the hospital where she was transplanted. She hasn't been able to continue her schooling because of so much illness, and she has decided to go back to school and take a limited schedule until her strength returns. What I am seeing about her is that she has managed her expectations, but at the same time, she is staying hopeful and optimistic about obtainable goals for herself. And I think she is going to do very, very well because she is doing very well.

Judy: Very interesting. You know, one thing we haven't talked about in all this coping with chronic illnesses is the dependence that sometimes just has to occur if you are sick and you need other people to take care of you. How does that play into the resilience thing? I mean, how do you be resilient and dependent by this, if you have to be dependent? Jackie Olds?

Dr. Olds: I think many people need to, essentially, be coached into graciously accepting dependence and even coming to enjoy the pleasures of dependence. As I say, there is such a kind of American embarrassment about dependence, but in fact it doesn't have to be dreadful at all.

Sometimes when I have patients who are going into the hospital for a medical reason, I remind them that there's a whole art of being a good patient, that you have to make the medical people at the hospital feel like they are being very effective or else they won't help as much. Because they like to feel that they are doing something useful, and that if you go in there and tell them what they are doing wrong, they won't be nearly as helpful. They need some positive feedback sometimes.

Judy: Yeah.

Dr. Olds: And similarly, learning how to be graciously dependent is kind of an art and a wonderful thing to learn how to do, but it doesn't come naturally to many of us.

Dr. Dorlen: Yeah. There are plenty of gender differences here, too, where you will see men who have been really John Wayne type men, you know, very, very independent, and they really become very depressed over their increasing dependence. Sometimes they do okay if they have a very trusting relationship with a significant other and wife and so forth, but they do have a difficult time. I find that women, maybe because of the varied roles that they play throughout their lives as caregivers, they can identify with someone who is in need of care and can actually allow themselves to be helped and to allow themselves a measure of dependence for a period of time.

Judy: Yeah. It's really a tough one because your ego can get in the way.

We are just about out of time. Dr. Jacqueline Olds, do you have any final advice you would like to leave us with tonight?

Dr. Olds: Well, I think what all of us will try to contribute to chronically ill people who have gotten themselves depressed or hopeless, try to sort of infuse them with some optimism and hope. That's sort of the job of the person who is trying to be helpful to the chronically ill person - when you are chronically ill, it's easy to kind of run out of gas, and we have to try to refuel that person with kind of a sense of hope and optimism.

Judy: Especially with what we have been talking about in terms of isolation, I assume that would include encouraging people to make the human connections, not just on the Internet, not just watching “Desperate Housewives,” right?

Dr. Olds: Exactly. Yes.

Judy: Okay. And Dr. Dorlen, how about you? Do you have a take home lesson for us?

Dr. Dorlen: My message is give yourself permission to have fun. Engage in life. Find purposeful activities that are meaningful. Do something you never did before, whether it's take a class, do some religious activities, put an ad in the paper, help someone else. Engage in life. I also tell my patients do three activities a day.

Judy: Like what?

Dr. Dorlen: Oh, it could be as much as arrange your sock drawer, but something.

Judy: I see. Well, thank you both very much. You have both been terrific. And I would like to thank you, the listeners, for joining us. Until next week, I'm Judy Foreman. Good night.

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